Finding the evidence for the rating scales

Before an ES review, both the trainee and the Ed Supervisor are required to rate the trainee against the 13 professional competencies – and you have to justify your rating with ‘good enough’ evidence. A lot of you seem to have difficulty with this write up. So, I’ve written this guide to make your lives easier. Please can you pay quite a bit of attention to your self-rating scale in your ePortfolio by reading this page carefully.

Where to find the evidence

It’s simple… scroll down and look at the list of competency headings below. Pick evidence from the things listed there (try and go for the items in blue because they provide the stronger evidence). However, if you have evidence from the remaining items, include that too; pack in as much evidence as you have – but be concise. Performance that is witnessed or observed generally carries more weight than performance that is inferred. For example, for the competency ‘Working With Colleagues’, evidence from an MSF (= comments from others on observed behaviour) has greater weight than say a CBD (= where you say what you think you did). The items in blue generally link to evidence that is observed.
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How to write it up

I’m going to present to you a method where you can provide evidence for each competency in a quantitative AND qualitative way. Quantitative means measuring something through numbers (or quantity). Qualitative means measuring something through its quality rather than numbers. Both are measures of how good something is.

For example, if I was to provide you with a beautifully decorated, delicious and moist cake, that would in some way (I hope) give you a bit of faith that I can bake a cake well. These three things – beautifully decorated, delicious taste, moist texture – is the qualitative evidence that proves this cake (that I made) is good! So, this qualitative evidence gives you some faith I can bake a cake and bake it well (i.e. some expression of my level of competency at baking a cake). But does this one cake tell you how consistent I am at making good cakes (which is another angle of competency)? No it doesn’t. For that – you need numbers (i.e. quantitative evidence). If I presented to you 10 perfectly baked, beautifully decorated, moist cakes – would you now be happy that I am a pretty good consistent cake baker? For those of you who said yes, are you sure? What if I told you I baked 50 cakes and 40 turned out bad and I only presented to you the 10 that were good? How consistent do you think am I now at baking cakes? Not so happy? What if my friend Ambar (who also bakes cakes) presented you 10 perfectly baked cakes but that Ambar only made 12 in total and only two turned out wrong? Whose the better baker, me or Ambar? (I hope you will say Ambar). Can you see that you cannot derive meaning from numbers without their denominator. Quantitative evidence needs to presented within the context of its denominator.

In summary, there are two aspects to how good I am at baking cakes – can I bake a cake that is of good quality (qualitative evidence) and can I repeatedly bake good quality cakes (quantitative evidence). In a similar way, you need to present your evidence for the competency rating scales in both a quantitative and qualitative way. And if you read on, I will show you how. Quantitative evidence can be found in things like the number of CBDs, COTs, miniCEXs, MSF, PSQ and CSR (essentially the elements of WPBA. Qualitative evidence can be found in individual log entries.

PROVIDE QUANTITATIVE EVIDENCE FIRST

In the free text boxes for each competency, provide quantitative evidence (i.e. focus on the numbers). In other words, focus on the number of pieces of WPBA evidence which demonstrate the competence rather than picking one or two learning log entries and talking about them in detail. Use the COT, CBD, CEX mapping sheets.

But remember what I said – numbers mean nothing without their denominator.

For example, for Practising Holistically, you might write…

7 out of 8 CBDs marked competent for Practising Holistically.

9 out of 11 COTs marked competent for Psychosocial Context.

CSR writes meet expectations for exploring ICE and impact on patient’s life.

MSF comments on ‘explores the impact of patient’s problems’

AS OPPOSED TO ‘Log Entry dated 11.2.14 shows a case where I did this, that and the other.’

ONLY THEN PROVIDE QUALITATIVE EVIDENCE

Tag individual Learning Log Entries as qualitative evidence. But be sure to only pick those learning log entries which will clearly demonstrate competence to any third partly reading that entry.

Once you have tagged it, you shouldn’t really need to explain or write anything further about that lag entry – because it should be apparent from the entry itself.

Do not pick entries that are a bit wishy washy or weak. It doesn’t look good if you link a weak entry that an independent third person cannot (at a glance) see the relevance to that competency.

You can use individual elements of WPBA as qualitative evidence – for instance, you could tag a particular CBD where you thought you demonstrated (say) ‘practising holistically’ well. But as you will probably have already used this evidence as quantitative evidence, try and go for evidence that you haven’t used (e.g. log entries) instead.

The green bit is quite specific about how the trainee plans to build on each competency in the near future.

Can you do something similar? I’m sure you can.

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COMMUNICATION & CONSULTATION SKILLS

Evidence

In all 9 COTS in this review items 1.2,3,4,8,9 and 11 are competent or above. In fact items 1 (patient contribution), 8 (appropriate language) and 11 (patient involvement) have been marked as Excellent in 2, 3 and 2 COTs respectively.

My PSQ was very good in all areas. Mean score generally 5 for most items and Median score generally 6.

10/05/2015 Learning log: Gentleman with unexplained back pain and lots of worries

Suggested Action Before Next Review

Maybe now try and look at difficult consultations and advanced consultation techniques. Start by finding a course on handling difficult consultations – and then put that into practise?

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MAKING A DIAGNOSIS/DECISIONS

Evidence

CBDs 9/11 competent for making a diagnosis/decisionCOTs item 6 appropriate examination 6/9 Competent, 2/9 excellent, 1 NFD. Item 7 Appropriate working diagnosis 9/9 competentPrevious CSR suggested to try and work more independently and to balance when to seek reassurance from others. Current CSR comments are that I meet expectations for diagnostics items appropriate differential diagnosis and refers appropriately with specific comments stating that clinically very good, and does not over or under investigate. MSF themes around having good clinical knowledge, explores differential diagnosis very well, good at knowing when to ask for help, thinks laterally when needed

Tagged Evidence

30/04/2015 Learning log: The girl who was taking the pill incorrectly

20/03/2015 Learning log: Home visit man with haematuria – what next?

25/04/2015 Learning log: Training in telephone triage

Suggested Action Before Next Review

I feel I have made incredible progress in terms of coping with uncertainty over the last 12 months. I would like to build on this further – perhaps read Tim Crossley’s book on ‘I Don’t Know What It Is But I Don’t Think It’s Serious’ (confidence and decisiveness in primary care).

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[toggle title_open=”How to write up the Suggested Action Point for each competency” title_closed=”How to write up the Suggested Action Point for each competency” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]

How to write up the Suggested Action Point for each competency

All trainees and Educational Supervisors need to write up reasonable action points for each competency. They must not be woolly or vague like ‘continue to build on this skill’.

Even if you are an ST3 who is completing to CCT, you STILL have to write action points for each of the Professional Competencies – because some of these will form the basis of your PDP for your very first GP appraisal. In the case of ST3s who are completing, the ‘suggested action before next review’ box should be interpreted as ‘suggested action before first appraisal’.

In summary, you need to write objectives which are SMART. It might make it easier just to think of what next practical step the doctor needs to take which is achievable within the first year post CCT.

CEX ?item 4: clinical judgement, 7: overall care and look at the ‘complexity of the case’ drop down box

MANAGEMENT

1. Organisation, Management, Leadership

CBD – item 6: Organisation, Management, Leadership

Logentries – esp NOE – audit

2. Community orientation

Community orientation only comes to life when we look at the impact of disease/provision of health care in the wider patient context. This is where the NOE of audit work or engaging in a project that looks at the patient population becomes invaluable. Incidentally, these are often the best ways of learning about this element of the curriculum.

[toggle title_open=”Another way of looking at where the evidence is” title_closed=”Another way of looking at where the evidence is” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]Another way of looking at where the evidence is: (but log entries not included)

[toggle title_open=”Remind me – what are the competences which form the framework for WPBA?” title_closed=”Remind me – what are the competences which form the framework for WPBA?” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]Remind me – what are the competences which form the framework for WPBA?

Communication and consultation skills. This competence is about communication with patients, and the use of recognised consultation techniques.

Practising holistically: the ability of the doctor to operate in physical, psychological, socioeconomic and cultural dimensions, taking into account feelings as well as thoughts.

Data gathering and interpretation: the gathering and use of data for clinical judgement, the choice of physical examination and investigations, and their interpretation.

Making a diagnosis / making decisions. This competence is about a conscious, structured approach to decision making.

Clinical management: the recognition and management of common medical conditions in primary care.

Managing medical complexity and promoting health: aspects of care beyond managing straightforward problems, including the management of co-morbidity, uncertainty, risk and the approach to health rather than just illness.

Primary care administration and IMT: the appropriate use of primary care administration systems, effective recordkeeping and information technology for the benefit of patient care.

Working with colleagues and in teams: working effectively with other professionals to ensure patient care, including the sharing of information with colleagues.

Community orientation: the management of the health and social care of the practice population and local community.

Maintaining performance, learning and teaching: maintaining the performance and effective continuing professional development of oneself and others.

Maintaining an ethical approach to practice: practising ethically with integrity and a respect for diversity.

Fitness to practise: the doctor’s awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk and the action taken to protect patients

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